Cuellar Hugo, Guimaraens Leopoldo, Ambekar Sudheer, Vivas Elio, Theron Jacques
Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA
Department of Interventional Neuroradiology, Hospital General de Catalunya, Neuroangiografia Terapeutica, Barcelona, Spain Department of Interventional Neuroradiology, Hospital Nuestra Señora del Rosario, Terapeutica Endovascular y Percutanea, Madrid, Spain.
Interv Neuroradiol. 2015 Apr;21(2):273-6. doi: 10.1177/1591019915581991. Epub 2015 May 11.
Direct carotid artery puncture (DCP) is employed in patients with tortuous anatomy and peripheral vascular disease when the peripheral arteries are not available for vascular access. Manual compression is the only method of achieving hemostasis following DCP and, till date, the use of a closure device for DCP has been reported in only one patient. In this study we sought to analyze our experience with the use of closure device for DCP.
This is a retrospective study of patients in whom Angioseal™ was used following DCP for neuroendovascular procedures. Medical charts and imaging of these patients was reviewed for any abnormalities pertaining to the use of the closure device.
A total of eight patients were included in the study. Angioseal™ was used in all the patients. There were no complications related to the use of the closure device in any of the eight patients. Immediate post-procedure angiography done in one patient did not show any structural or hemodynamic abnormalities within the carotid artery lumen. At 6 months follow-up imaging, there was no evidence stenosis or vascular wall abnormality in any of the patients. There were no adverse clinical reactions related to the use of closure device.
In our experience, Angioseal™ may be a safe and off-label effective closure device for patients undergoing DCP for neuroendovascular procedures. It obviates the need for manual compression without causing any structural or hemodynamic changes within the carotid artery. Larger studies with longer follow-up are required to establish its safety in patients undergoing DCP.
当外周动脉无法用于血管通路时，对于解剖结构迂曲和患有外周血管疾病的患者，会采用直接颈动脉穿刺（DCP）。手动压迫是DCP后实现止血的唯一方法，迄今为止，仅报道过1例患者在DCP后使用闭合装置。在本研究中，我们试图分析我们使用闭合装置进行DCP的经验。
这是一项对在神经血管内介入手术中DCP后使用Angioseal™的患者的回顾性研究。对这些患者的病历和影像学检查进行回顾，以查找与使用闭合装置相关的任何异常情况。
本研究共纳入8例患者。所有患者均使用了Angioseal™。8例患者中无一例出现与使用闭合装置相关的并发症。1例患者术后立即进行的血管造影显示颈动脉管腔内无任何结构或血流动力学异常。在6个月的随访影像学检查中，所有患者均无狭窄或血管壁异常的证据。未出现与使用闭合装置相关的不良临床反应。
根据我们的经验，对于接受神经血管内介入手术DCP的患者，Angioseal™可能是一种安全且未获批准但有效的闭合装置。它无需手动压迫，且不会引起颈动脉内的任何结构或血流动力学变化。需要进行更大规模、更长随访期的研究来确定其在接受DCP患者中的安全性。
